<div class="row">
                    	
                        <div class="col-lg-12 col-md-12 col-sm-12">
                        	
                            <div class="carousel-heading no-margin">
                                <h4>Add a comment</h4>
                            </div>
                            
                            <div class="page-content">
                            	
                                <div class="row">
                                	
                                    <div class="col-lg-6 col-md-6 col-sm-8">
                                    
                                    	<label>Name (required)</label>
                                        <input type="text">
                                        <br><br>
                                        <label>E-mail (required, but will not display)</label>
                                        <input type="text">
                                        <br><br>
                                        <label>Website (required)</label>
                                        <input type="text">
                                        <br><br>
                                        <label>Comment (required)</label>
                                        <textarea></textarea>
                                        <br><br>
                                        <input type="checkbox"><label>Notify me of follow-up comments</label>
                                        <br><br>
                                        <img src="@routes.Assets.at("images/captcha.jpg")" alt="">
                                        <br><br>
                                        <div class="row">
                                        	
                                            <div class="col-lg-6 col-md-6 col-sm-6">
                                            	<label><a href="#">Refresh</a></label>
                                        		<input type="text">
                                            </div>
                                            
                                        </div>
                                        <br>
                                        <input type="submit" value="Submit comment" class="dark-blue big">
                                        
                                    </div>
                                
                                </div>
                                
                            </div>
                            
                    	</div>
                        
                    </div>